Parkinson's Disease - Surgery

Surgery

Brain surgery may be considered when drugs fails to control symptoms of Parkinson's disease or cause severe or disabling side effects.⁸

Deep brain stimulation (DBS) is a technique for treating Parkinson's disease. It affects movement by using electrical impulses to stimulate a target area in the brain. The electrical impulses are generated by wire electrodes surgically placed in the brain. Deep brain stimulation may be used in addition to therapy with levodopa or other drugs when drugs alone do not control symptoms adequately. This technique is the preferred surgical method of treating most cases of advanced Parkinson's disease. It does not destroy brain tissue and has fewer risks than older, more destructive surgical methods, such as pallidotomy and thalamotomy.⁸

Pallidotomy and thalamotomy are rarely done anymore. They involve the precise destruction of very small areas in the deep part of the brain that cause symptoms.

Neurotransplantation surgery is an experimental procedure being studied for the treatment of Parkinson's disease. It involves implanting cells that produce dopamine into the brain. Information about the effectiveness of neurotransplantation is limited, and it is not a proven treatment or a realistic option for most people at this time.

Surgery Choices

Deep brain stimulation

Pallidotomy

Thalamotomy

Neurotransplantation

What To Think About

A neurologist with special training in Parkinson's disease is most often the best kind of doctor to make a decision about surgery. If you might benefit from surgery or deep brain stimulation, your neurologist can refer you to a brain surgeon with experience doing these operations.

Surgery most often becomes a treatment option for people when Parkinson's disease progresses to the point that drugs can no longer control symptoms adequately. With advanced disease, existing symptoms may get worse, or a person may develop new symptoms that drugs cannot control. (However, when a person has severe one-sided tremor, deep brain stimulation [DBS] may be considered much sooner because this symptom often responds better to DBS than to medicine.)

People who have extremely advanced Parkinson's or who have other serious conditions (such as heart or lung disease, cancer, or kidney failure) are not usually good candidates for surgery. Surgery is usually not considered for people who have dementia or psychiatric disorders.

Surgery is not a cure for Parkinson's disease. Drugs are usually still necessary after surgery, but surgery can reduce the number and amount of drugs needed to control symptoms. This reduces the side effects caused by drugs while at the same time controlling symptoms.

Deep brain stimulation

Deep brain stimulation (DBS) neither cures Parkinson's disease nor eliminates the need for medicine. DBS of the thalamus is done to treat disabling tremor caused by Parkinson's disease. Procedures that stimulate the subthalamic nucleus and the globus pallidus control a wider range of symptoms (in addition to tremor) and are used more often than stimulation of the thalamus.

Pallidotomy and thalamotomy

Few brain surgeons (neurosurgeons) perform pallidotomy, and neither pallidotomy nor thalamotomy is commonly done anymore.

Neurotransplantation

The neurotransplantation procedure is still experimental and has been done on only a very small number of people. Its full effects take several months or longer to appear and no proven benefit has been documented to date.